Cost-effectiveness analysis of health tapestry, a complex primary care program for older adults: a post-hoc analysis.

BACKGROUND: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. METHODS: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. RESULTS: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. CONCLUSION: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site.

Cartografia das estratégias utilizadas para o trabalho colaborativo em equipes de saúde da família / Cartografía de las estrategias utilizadas para el trabajo colaborativo en equipos de salud de la familia / Strategies used for collaborative work in family health teams: a cartographic analysis

O estudo objetivou mapear as estratégias utilizadas para o trabalho colaborativo em equipes de Saúde da Família (eSF) inseridas na Atenção Primária à Saúde (APS), em um município do norte de Minas. Trata-se de um estudo qualitativo, com a proposta metodológica da Cartografia. Os dados foram produzidos em quatro eSF por meio de observação participante, questionário de identificação, diário cartográfico, entrevista semiestruturada individual e grupo focal. A análise do discurso e o rastreio cartográfico possibilitaram a construção de duas categorias temáticas e um mapa cartográfico. Alcançou-se que as estratégias, consideradas linhas de fuga, permitem transformações existenciais no trabalho em equipe, pois originam nascentes em solos cristalizados, pensamentos problematizadores, subjetividade e interações disciplinares. Concluiu-se que as linhas duras não devem ser eliminadas do trabalho em equipe, pois coexistem nessa realidade, e o que importa é como são vivenciadas nas relações.

El objetivo del estudio fue mapear las estrategias utilizadas para el trabajo colaborativo en equipos de Salud de la Familia (eSF), inseridas en la Atención Primaria de la Salud, en un municipio del Norte de Minas Gerais. Se trata de un estudio cualitativo, con la propuesta metodológica de la Cartografía. Los datos se produjeron en cuatro eSF, por medio de observación participativa, cuestionario de identificación, diario cartográfico, entrevista semiestructurada individual y grupo focal. El análisis del discurso y el rastreo cartográfico posibilitaron la construcción de dos categorías temáticas y un mapa cartográfico. Se vio que las estrategias, consideradas líneas de fuga, permiten transformaciones en el trabajo en equipo, puesto que originan manantiales en suelos cristalizados, pensamientos problematizadores, subjetividad e interacciones disciplinarias. Se concluyó que las líneas duras no deben eliminarse del trabajo en equipo, puesto que coexisten en esta realidad y lo que importa es cómo se experimentan en las relaciones.

The study aimed to map the strategies used for collaborative work in Family Health Teams (FHT), inserted in Primary Health Care, in a municipality in the North of Minas. This is a qualitative study, with the methodological proposal of Cartography. Data were produced in four FHT, through participant observation, identification questionnaire, cartographic diary, semi-structured individual interview and focus group. Discourse analysis and mapping screening enabled the construction of two thematic categories and a cartographic map. It was reached that the strategies, considered lines of flight, allow existential transformations in teamwork, since they originate springs in crystallized soils, problematizing thoughts, subjectivity, and disciplinary interactions. It was concluded that hard lines should not be eliminated from teamwork, for they coexist in this reality, and what matters is how they are experienced in relationships.

Uma revisão narrativa do apoio matricial em saúde mental entre as equipes CAPS-ESF no cenário brasileiro / A narrative review of matrix support in mental health among the CAPS-ESF teams in Brazil

Resumo A pesquisa teve como objetivo identificar como acontece o Apoio Matricial realizado entre o Centro de Atenção Psicossocial (CAPS) e as equipes de Saúde da Família. Ocorreu a partir de uma revisão narrativa da literatura feita através de uma busca utilizando como descritores "apoio matricial AND saúde mental", nas bases da SciELO e PubMed, entre 2016 e 2020, com 12 estudos selecionados. Após a leitura do conjunto do material, dois eixos temáticos foram construídos: apoio CAPS-ESF na prática e seus alcances e elementos facilitadores e desafiadores. O Apoio Matricial é ferramenta essencial à Reforma Psiquiátrica; recurso de fortalecimento entre os serviços de saúde mental especializada e Atenção Básica. Os desafios envolvem o campo das relações entre os sujeitos implicados nos serviços de saúde mental, incluindo a gestão, nas limitações do próprio trabalho em equipe, e nas fragilidades estruturais da rede de saúde mental. Por fim, os estudos convergem em destacar que o cuidado compartilhado entre apoiadores só é possível por meio de encontros e desencontros entre as equipes, sendo trabalho complexo por seu caráter de construção.

Abstract The research aimed to identify how the Matrix Support carried out between the Psychosocial Care Center (CAPS) and the Family Health teams takes place. It occurred from a narrative review of the literature carried out through a search using "matrix support AND mental health" as descriptors, in the SciELO and PubMed databases, between 2016 and 2020, with 12 studies selected. After reading the set of material, two thematic axes were constructed: CAPS-ESF support in practice and its scope and facilitating and challenging elements. Matrix Support is an essential tool for Psychiatric Reform; strengthening resource between specialized mental health services and Primary Care. The challenges involve the field of relationships between subjects involved in mental health services, including management, the limitations of teamwork itself, and the structural weaknesses of the mental health network. Finally, the studies converge in highlighting that shared care between supporters is only possible through meetings and disagreements between teams, being a complex work due to its construction nature.

Strengthening Primary Healthcare in Jordan for Achieving Universal Health Coverage: A Need for Family Health Team Approach.

Achieving Universal Health Coverage (UHC) is a strategic objective of the Jordanian government and has been prioritized in its strategies and plans. However, there are several challenges affecting primary healthcare in Jordan and the health system in general that prevent Jordan from achieving UHC. This paper highlights the importance of team-based care in the form of Family Health Teams (FHTs) to realize Jordan's goal of achieving UHC. FHTs are a team-based approach that brings together diverse professionals to provide a comprehensive, efficient, patient-centered primary care system that meets the changing needs of Jordan's population and refugees. However, the implementation of FHT may encounter obstacles, including individual, organizational, institutional, and external barriers. To overcome such obstacles, several actions and processes need to be taken, including political commitment and leadership, implementing good governance and policy frameworks, allocating resources and funding, multisectoral collaboration, and engagement of communities and stakeholders. The successful implementation of FHTs requires participation from government officials, parliamentarians, civil society, and influential community, religious, and business leaders. A strategic policy framework, effective oversight, coalition building, regulation, attention to system design, and accountability are also essential. In conclusion, adopting the FHT approach in Jordan's Primary Healthcare system offers a promising path towards achieving UHC, improving healthcare access, quality, and efficiency while addressing the unique challenges faced by the country's healthcare system.

Plan de acción para el control de la hipertensión arterial en pacientes de Arame-Maranhão, Brasil

RESUMEN Introducción: La hipertensión arterial es una condición clínica que provoca el ingreso de un gran número de pacientes en los sectores de emergencia y urgencia de los servicios hospitalarios. El número de hipertensos en el grupo de edad de 18 a 90 años es cada vez mayor en la Unidad Básica de Salud João Paulo II, Arame, estado de Maranhão. Objetivo: Implementar un plan de acción para el óptimo control de la hipertensión arterial sistémica en las comunidades de cobertura del puesto de salud en estudio durante el periodo diciembre de 2017 hasta junio de 2018. Método: Se realizó un estudio de intervención en 467 hipertensos, de un universo de 935 pacientes. El dato primario se obtuvo de las historias clínicas. Se estudiaron las variables: edad, sexo, hábitos tóxicos, índice de masa corporal, hábitos dietéticos, actividad física y cumplimiento del tratamiento médico. Resultados: Después de la intervención, la asistencia al puesto de salud, la reevaluación del tratamiento, los ingresos y el control arterial mejoraron sustancialmente a 4,0 %, 3,7 %, 0,2 % y 9,8 %, respectivamente. Conclusiones: Existe la necesidad de intervenir en el cuidado de los pacientes hipertensos y de la población en general para transformar los estilos de vida y los factores de riesgo que garanticen la reducción de la incidencia de la hipertensión arterial sistémica, todo esto favorece el aumento de la adherencia al tratamiento, mejora el seguimiento médico y contribuye a disminuir las complicaciones y los ingresos hospitalarios.

ABSTRACT Introduction: Arterial hypertension is a clinical condition that causes the admission of a large number of patients in the emergency and urgency areas of the hospital services. The number of hypertensive patients in the age group from 18 to 90 years of age is increasing in the João Paulo Basic Health Unit II, in Arame, Maranhão state. Objective: To implement an action plan for the optimal control of systemic arterial hypertension in the communities covered by the health institution under study, during the period from December 2017 to June 2018. Method: An intervention study was carried out in 467 hypertensive patients, out of a population of 935 individuals. The primary data was obtained from the medical records. The variables studied were: age, sex, toxic habits, body mass index, dietary habits, physical activity and compliance with medical treatment. Results: After the intervention, the attendance, treatment reassessment, admissions, and control of arterial figures improved substantially to 4.0%, 3.7%, 0.2%, and 9.8%, respectively. Conclusions: There is a need to intervene in the care of hypertensive patients and the general population to transform lifestyles and risk factors that guarantee the reduction of the incidence of systemic arterial hypertension, all of which favors the increase in adherence to treatment, improves medical follow-up and contributes to reducing complications and hospital admissions.

RESUMO Introdução: A hipertensão arterial é uma condição clínica que ocasiona a admissão de grande número de pacientes nos setores de urgência e emergência dos serviços hospitalares. O número de hipertensos na faixa etária de 18 a 90 anos está aumentando na Unidade Básica de Saúde João Paulo II, Arame, Maranhão. Objetivo: Implementar um plano de ação para o controle ótimo da hipertensão arterial sistêmica nas comunidades abrangidas pelo posto de saúde em estudo durante o período de dezembro de 2017 a junho de 2018. Método: Foi realizado um estudo de intervenção em 467 hipertensos, de um universo de 935 pacientes. Os dados primários foram obtidos dos prontuários médicos. As variáveis estudadas foram: idade, sexo, hábitos tóxicos, índice de massa corporal, hábitos alimentares, atividade física e adesão ao tratamento médico. Resultados: Após a intervenção, o atendimento ao posto de saúde, a reavaliação do tratamento, as admissões e o controle do controle arterial melhoraram substancialmente para 4,0%, 3,7%, 0,2% e 9,8%, respectivamente. Conclusões: Há necessidade de intervir no cuidado dos hipertensos e da população em geral para transformar estilos de vida e fatores de risco que garantam a redução da incidência de hipertensão arterial sistêmica, o que favorece o aumento da adesão ao tratamento, melhora o acompanhamento médico -up e contribui para a redução de complicações e internações hospitalares.

Improving Health Equity by Screening for Poverty: A Survey of Family Physician Screening Behaviors and Perceptions in Toronto, Canada.

Purpose: Given the importance of socioeconomic status in both directly and indirectly influencing one's health, "poverty screening" by family physicians (FPs) may be one viable option to improve patient health. However, rates of screening for poverty are low, and reported barriers to screening are numerous. This study sought to collate and investigate reasons for refraining from screening among FPs, many of whom had opted into a Targeted Poverty Screening (TPS) Program, to be able to enhance uptake of the intervention. The TPS Program is a "targeted screening and referral process," whereby medical charts of adult patients residing in "deprived neighborhoods," as determined by postal code, were flagged for screening for FPs who elected to partake in the program. Methods: A survey containing 15 questions was developed through an iterative process with pilot-testing by faculty physicians. The survey was administered to FPs registered in the North York Family Health Team (NYFHT) using Qualtrics© research software. Results: Half of the respondents (n=19/38; 50%) indicated that they enrolled in the TPS program. Irrespective of enrollment in the TPS Program, the majority of respondents (n=31/38; 81.6%) stated that they elect to screen their patients for poverty using the evidence-based question of "do you have difficulty making ends meet at the end of the month?." Among those not enrolled in the program, 84.2% (n=16/19) of respondents indicated that they screened their patients for poverty and 15.8% (n=3/19) indicated they did not. Among respondents who said they did not screen (n=7/38; 18.4%), the reasons for not screening patients were as follows: forgot (n=2; 28.6%); time constraints/feel uncomfortable asking (n=1; 14.3%); and "feel I know patients well" (n=1; 14.3%). For the remaining respondents, a nurse or locum did the screening as part of a periodic health review (i.e., patient was screened, but not by the FP completing the survey (n=3). Conclusion: This study yielded numerous insights, such as barriers faced by FPs in undertaking poverty screening that differs from the literature. The findings suggest that (1) barriers faced by FPs in poverty screening can be mitigated, (2) there is a need to integrate screening into routines and normalize the activity, and (3) there is a need for enhanced training to support patients of lower socioeconomic status.

Team-based primary care practice and physician's services: Evidence from Family Health Teams in Ontario, Canada.

Team-based primary care offers a wide range of health services to patients by using interdisciplinary health care providers committed to delivering comprehensive, coordinated and high-quality care through team collaboration. Ontario's Family Health Team (FHT), the largest team-based practice model in Canada, was introduced to improve access to and effectiveness of primary health care services, and was available primarily for physicians paid under blended capitation models (Family Health Organizations and Family Health Networks). Using health administrative data on physicians practicing under blended capitation models in Ontario between 2006 and 2015, we study the impact of switching from non-FHT to FHTs on the production of capitated comprehensive care services, after-hours services, non-incentivized services, and services provided to non-enrolled patients by family physicians. We find that when in FHTs, physicians increase the production of total services and non-incentivized services by 26% and 5% per annum and reduce capitated comprehensive care services by 3.2% per annum. When in FHTs, physicians also see and enroll more patients relative to those practicing in non-FHTs. We find evidence of improved access to physician's services under team-based primary care, but switching to FHTs has no effect on the production of after-hours services and services provided to non-enrolled patients.

A qualitative study on the implementation of family health team: the perspectives of providers and patients.

BACKGROUND: Malaysia has committed to the global call to achieve universal health coverage, and with the adoption of Sustainable Development Goals, is further strengthening the health system through the primary health care services, particularly the family doctor concept. The Enhanced Primary Health Care (EnPHC) initiative was implemented to address the worrying upward trend of non-communicable disease prevalence, and incorporates the Family Health Team (FHT) concept. The aim of this paper is to describe the implementation of the FHT as part of the EnPHC intervention. METHODS: In-depth interviews and focus group discussions were conducted with the intervention design team, healthcare providers and patients in two rounds during the implementation period. A total of 121 individuals in the two rounds, split into different groups, where some of the participants of the FGD were also interviewed individually. Data were analysed using a thematic analysis, with codes being organised into larger themes. RESULTS: Themes that emerged from the data were around the process of FHT implementation and the advantages of the FHT, which included continuity of health care and improved quality of care. Patients and health care providers were receptive to the FHT concept, and took the effort to adapt the concept in the local settings. CONCLUSIONS: The FHT concept implemented at 20 public primary health clinics has benefits appreciated by health care providers and patients. Addressing the viable shortcomings would better prepare the current primary healthcare system to scale up the FHT concept nationwide and enhance its feasibility and sustainability. TRIAL REGISTRATION: The study is registered with the National Medical Research Register, Ministry of Health Malaysia ( NMRR-17-295-34711 ).

Evaluating Attitudes Toward Interprofessional Collaboration and Education Among Health Professional Learners.

BACKGROUND: An interprofessional education (IPE) workshop was established to enhance knowledge, skills, and attitudes for health professional learners to engage in interprofessional collaboration (IPC) through group-based activities. This study evaluates the IPC attitudes of learners following the IPE workshop. METHOD: Learner attitudes were measured pre- and post-workshop with the validated ICCAS survey for years 2017 and 2018. Areas such as communication and collaboration were assessed using a 7-point Likert scale ranging from strongly agree to strongly disagree. RESULTS: 161/420 (38%) and 399/446 (89%) of surveys were completed in 2017 and 2018. Median scores were significantly higher post-workshop for both years (p < 0.001). Pre-test differences were observed between Medicine and Pharmacy in both years and post-test differences between Optometry and Nursing in 2018. CONCLUSION: Positive outcomes are being observed among learners through IPC educational events. Further research is required to determine whether such activities promote IPC in future practice.

Configurações do processo de trabalho em núcleos de apoio à saúde da família e o cuidado integral / Work process configurations in family health support centers and comprehensive care / Configuraciones del proceso de trabajo en núcleos de apoyo a la salud de la familia y el cuidado integral

Resumo O estudo tem como objetivo sistematizar as configurações de Núcleos de Apoio à Saúde da Família. Trata-se de uma pesquisa qualitativa realizada em três municípios da Região Metropolitana do Recife, que utilizou dados coletados com grupos focais em três Núcleos de Apoio à Saúde da Família, analisados por meio da técnica de condensação de significados. Os resultados permitiram sistematizar três tipos de configurações: assistencial-curativista, que apresenta um distanciamento intenso do objetivo do Núcleo de Apoio à Saúde da Família; semimatricial, considerado uma configuração intermediária, e o matricial, que se aproxima mais do modelo ideal, preconizado pelo Ministério da Saúde. Conclui-se que existe, nos três municípios, uma proposta recente, frágil e que, apesar de ter potencialidades, é permeada por conflitos, contestações e incertezas. As informações obtidas podem subsidiar o planejamento e a execução de ações que busquem romper com vários conceitos hegemônicos norteadores da atuação dos profissionais de saúde na atenção básica.

Abstract The aim of this study was to systematize the configurations of Family Health Support Centers. A qualitative study was conducted in three municipalities of metropolitan Recife, in the state of Pernambuco, Brazil, and considered data collected from focus groups in three Family Health Support Centers and analyzed through the meaning condensation technique. The study's findings allowed the systematizing of three types of configurations: the assistive-curative, which shows great distancing from the family health support center's goals; the semi-matrical, considered to be an intermediary configuration, and the matrical, which stays closer to the ideal model, recommended by the Ministry of Health. In conclusion, there is, on all three municipalities, a recent and fragile family health proposal that, despite its potentialities, is permeated with conflicts, contestations and uncertainties. The findings of the present study can assist in the planning and execution of actions that seek to break from various hegemonic concepts regarding the work of primary healthcare professionals.

Resumen El estudio tiene como objetivo sistematizar las configuraciones de Núcleos de Apoyo a la Salud de la Familia. Se trata de una investigación cualitativa realizada en tres municipios de la Región Metropolitana de Recife, que utilizó datos recogidos con grupos focales en tres Núcleos de Apoyo a la Salud de la Familia, analizados por medio de la técnica de condensación de significados. Los resultados permitieron sistematizar tres tipos de configuraciones: asistencial-curativista, que presenta un gran distanciamiento del objetivo del Núcleo de Apoyo a la Salud de la Familia; semimatricial, considerada una configuración intermedia; y matricial, que se aproxima más al modelo ideal propuesto por el Ministerio de Salud. Se concluyó que en los tres municipios existe una propuesta reciente, frágil y que, a pesar de tener potencial, es atravesada por conflictos, discordancias e inseguridades. La información obtenida puede ayudar a la planificación y ejecución de acciones con el objetivo de romper varios conceptos hegemónicos que orientan la práctica de los profesionales de salud en la atención básica.

Ecobiological context of home visits from the perspective of users in the municipality of Aracaju, state of Sergipe - SE, Brazil / Contexto ecobiológico da visita domiciliar sob a perspectiva dos usuários no município de Aracaju/SE

A quantitative study was conducted in the municipality of Aracaju/State of Sergipe - SE, Brazil, to construct and analyse the ecomap of users (216 users) who received a home visit from the Family Health Teams (Equipes de Saúde da Família). The study showed that half of the users (50.5%) were over 60 years old, 77.8% were female, 68.0% had a low educational level, 49.1% were retired, 83.3% reported being bedridden, 53.2% reported a chronic injury as the reason for having the visit, 62.5% did not know the nursing assistant professional, 58.8% had a family caregiver, 94.4% considered the visit important, and 75.9% were informed about their right to a visit but considered it a privilege. The home visit is perfectly feasible, humanising and welcoming; it is a unique opportunity to immerse into and get to know the environment of families, delivering services in a more humane and welcoming space.

Estudo quantitativo realizado no município de Aracaju/Se que objetivou a construção e análise de ecomapa do universo de usuários (216 usuários) que receberam visita domiciliar das Equipes de Saúde da Família. O estudo revelou que metade dos usuários (50,5%) tinham mais de 60 anos, 77,8% eram do gênero feminino, 68,0% com baixa escolaridade, 49,1% aposentados; 83,3% relataram o fato de estarem acamados e 53,2% referiram agravo crônico como motivo para receber a visita, 62,5% desconheciam o profissional auxiliar de enfermagem, 58,8% tinham cuidador familiar, 94,4% consideravam a visita importante e 75,9% foram informados do direito a visita, mas a consideravam um privilégio. A visita domiciliar é perfeitamente exeqüível, humanizadora e acolhedora; é uma oportunidade ímpar de imergir e conhecer o ambiente das famílias, prestando atendimento em espaço mais humano e acolhedor.

Self-efficacy for deprescribing: A survey for health care professionals using evidence-based deprescribing guidelines.

BACKGROUND: Although polypharmacy is associated with significant morbidity, deprescribing can be challenging. In particular, clinicians express difficulty with their ability to deprescribe (i.e. reduce or stop medications that are potentially inappropriate). Evidence-based deprescribing guidelines are designed to help clinicians take action on reducing or stopping medications that may be causing more harm than benefit. OBJECTIVES: Determine if implementation of evidence-based guidelines increases self-efficacy for deprescribing proton pump inhibitor (PPI), benzodiazepine receptor agonist (BZRA) and antipsychotic (AP) drug classes. METHODS: A deprescribing self-efficacy survey was developed and administered to physicians, nurse practitioners and pharmacists at 3 long-term care (LTC) and 3 Family Health Teams in Ottawa, Canada at baseline and approximately 6 months after sequential implementation of each guideline. For each drug class, overall and domain-specific self-efficacy mean scores were calculated. The effects of implementation of each guideline on self-efficacy were tested by estimating the difference in scores using paired t-test. A linear mixed-effects model was used to investigate change over time and over practice sites. RESULTS: Of eligible clinicians, 25, 21, 18 and 13 completed the first, second, third and fourth survey respectively. Paired t-tests compared 14 participants for PPI and BZRA, and 9 for AP. Overall self-efficacy score increased for AP only (95% confidence intervals (CI) 0.32 to 19.79). Scores for domain 2 (develop a plan to deprescribe) increased for PPI (95% CI 0.52 to 24.12) and AP guidelines (95% CI 2.46 to 18.11); scores for domain 3 (implement the plan for deprescribing) increased for the PPI guideline (95% CI 0.55 to 14.24). Longitudinal analysis showed an increase in non-class specific scores, with a more profound effect for clinicians in LTC where guidelines were routinely used. CONCLUSION: Implementation of evidence-based deprescribing guidelines appears to increase clinicians' self-efficacy in developing and implementing a deprescribing plan for specific drug classes.

Understanding the use of emergency department and urgent care services by diabetic patients of a Family Medicine Health Team: a retrospective observational study.

Aim To understand the frequency, urgency, and rationale of emergency department and urgent care (ED/UC) use by diabetic patients of a Family Medicine Health Team (FHT). METHODS: A retrospective, observational study with comparison control groups was conducted from 1 January 2013 to 31 December 2014. A total of 693 diabetic patients were compared with two, age-standardized non-diabetic groups: one with a higher disease burden based on International Classification of Diseases 9 diagnoses and the other from a randomized patient pool. Findings The diabetic group utilized ED/UC services 1.25 and 1.92 times more often than the two control populations, consistent with that observed in other studies. Canadian Triage and Acuity Scale scores were essentially the same for the diabetic population. Only 3.1% of visits were for diabetic related emergencies, in contrast to the expected 23% by surveyed physicians of the FHT. Diabetic patient's sought treatment for cellulitis, wounds, abscesses, and infections more often than the control populations.

Avaliação dos efeitos da implantação do programa equipe de saúde da família Ribeirinha na Amazônia legal

A dificuldade para acessar o serviço de saúde ainda é uma realidade desiguale excludente para a maioria das comunidades ribeirinhas, cuja situação geográfica é uma barreira à democratização da utilização do sistema de saúde. Desta forma, visando ampliar o acesso à Atenção Básica e reduzir a taxa de mortalidade infantil, o Ministério da Saúde criou uma nova modalidade de equipe que atenderia as necessidades diferencia das dessa população. O presente estudo tem como principal finalidade a avaliação dos efeitos da implantação do Programa equipe de Saúde da Família Ribeirinha na Amazônia Legal, realizando uma análise comparada orientada por um delineamento quase-experimental, com uma estratégia metodo lógica diversificada. Foi realizada uma análise de conteúdo qualitativa da caracterização do programa e adotado o referencial Donabedian (1980) para a avaliação comparativa de estrutura, processo e resultado, com desenho pré-teste e pós-teste, em grupos de controle não-equivalentes, utilizando indicadores do Caderno de Diretrizes, Objetivos, Metas e Indicadores–2013/2015 e do 2º ciclo do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica. Em relação à estrutura, foram comparados os recursos financeiros, humanos e instalações físicas, apontando para efeitos positivos no grupo caso, como um maior investimento na saúde,a ampliação dos serviços e a prática multiprofissional de ações de saúde integrais e resolutivas...

The difficulty in accessing health services is still an unequal and excludin greality for most of the riverside communities, whose geographic context is a barrier to health system using democratization. There fore, aiming to spread the access to Basic Attention and reduce the child mortality rate, Health Ministery has created a new health personnel model that would attend to the different necessities of the river side population. The present study intends mainly to evaluate the Programa Equipe de Saúde da Família Ribeirinha na Amazônia Legal implantation effects, by an oriented compering analysis through an almost-experimental outlining, with a diverse methodological strategy. A qualitative content analysis of the program characterization has been made and the Donabedian (1980) referential has been used in the comparative evaluationof structure, process and result. A pre-test and post-test delineation was established and non-equivalents control groups were applied by using the rates form Caderno de Diretrizes, Objetivos, Metas e Indicadores-2013/2015 3 from the second cyc le of Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). About the structure, financial and human resources were compered, aswere the facilities, indicating the presence of positive effects in the case group, such as a bigger investment in health issues, services spreading and multi professional practices in resolutive integral health actions...

Contextual determinants of decentralization of epidemiological surveillance for the family health team / Determinantes contextuais da descentralização da vigilância epidemiológica para equipe de saúde da família / Determinantes contextuales de la descentralización de la vigilancia epidemiológica para el equipo de salud de la familia

This study examines the contextual determinants of implementing decentralization of epidemiological surveillance for the family health team, in a municipality in the state of Bahia, Brazil. This was an evaluative study using the political model of implementation analysis. Data were obtained through document analysis and semi-structured interviews with managers and healthcare workers. Five themes emerged: planning; training of human resources; organization of the work process; linkage within institutions; and organization of family healthcare units. The results revealed that there are difficulties such as poor infrastructure of healthcare units, creation of flexibility in labor relations and healthcare worker turnover. The study shows that there is a need for stakeholder participation in the process of implementing the policy of decentralization of epidemiological surveillance for the micro-area of intervention that comprises the family health program.

Este estudo analisa os determinantes contextuais da implantação da descentralização da vigilância epidemiológica para a Equipe de Saúde da Família, em um município do estado da Bahia, Brasil. Trata-se de pesquisa avaliativa, adotando-se o modelo político da análise de implantação. Os dados foram obtidos mediante a análise de documentos e entrevistas semiestruturadas aplicadas a gestores e trabalhadores da saúde. Emergiram cinco temas: Planejamento; capacitação de recursos humanos; organização do processo de trabalho; articulação intrainstitucional; organização da Unidade de Saúde da Família. Os resultados revelam dificuldades tais como: precária infraestrutura das unidades de saúde, flexibilização das relações de trabalho, rotatividade dos trabalhadores da saúde. O estudo aponta para a necessidade de participação dos atores no processo de implementação da política de descentralização da vigilância epidemiológica para um micro-espaço de intervenção que é o Programa de Saúde da Família.

Este estudio analiza las determinantes contextuales de la implantación de la descentralización de la vigilancia epidemiológica para el Equipo de Salud de la Familia, en un municipio de Bahia, Brasil. Se realizó un estudio de evaluación, adaptándose el modelo político del análisis de implantación. Los datos se obtuvieron por medio del análisis de documentos y entrevistas semi-estructuradas realizadas con gestores y trabajadores de la salud. Surgieron cinco temas: Planificación, capacitación de recursos humanos, organización del proceso de trabajo, articulación intra-institucional, organización de la Unidad de Salud de la Familia. Los resultados muestran dificultades: precaria infraestructura de las unidades de salud, flexibilización de las relaciones de trabajo, rotación de los trabajadores de la salud. El estudio señala la necesidad de participación de los actores en el proceso de implementación de la política de descentralización de la vigilancia epidemiológica para un micro espacio de intervención que es el programa de Salud de la Familia.

Predictors of Low-Acuity Emergency Department Use by Patients Enrolled in a Family Health Team.

BACKGROUND: The primary aim of this study was to determine the characteristics and develop a predictive model describing low acuity users of the emergency department (ED) by patients followed by a family health team (FHT). The secondary aim was to contrast this information with characteristics of high acuity users. We also sought to determine what factors were predictive of leaving without being seen (LWBS). METHODS: This retrospective descriptive correlational study explored characteristics and factors predictive of low acuity ED utilization. The sample included all FHT patients with ED visits in 2011. The last ED record was chosen for review. Sex, age, Canadian Triage and Acuity Scale (CTAS), presenting complaint(s), time of day, day of week, number of visits, and diagnosis were recorded. RESULTS: Of 1580 patients who visited the ED in 2011, 56% were CTAS 1-3 visits, 24% CTAS 4-5 and 20% had no CTAS recorded. Patients who were older than age 65 were approximately half as likely to have a CTAS level of 4-5 compared to younger patients (OR=0.605, CI=0.441,0.829). Patients older than age 65 were 1.75 times more likely to be CTAS level 1-2 (OR=1.745, CI=1.277, 2.383). Patients who went to the ED during the day were less likely to LWBS compared to night visits (OR=0.697, CI=0.532, 0.912). Interpretation Most low acuity ED utilization is by patients under the age of 65, while high acuity ED utilization is more common among patients older than age 65. Patients are more likely to LWBS during late evening and overnight periods (9 pm-7 am).

Physical activity as medicine among family health teams: an environmental scan of physical activity services in an interdisciplinary primary care setting.

A Family Health Team (FHT) is a multi-disciplinary primary healthcare model that may be an ideal setting to engage patients in physical activity. An environmental scan was conducted to determine the prevalence and characteristics of physical activity services offered by FHTs in Ontario. Of the 186 FHTs, 102 (55%) completed the survey. Almost 60% of responding FHTs offered a physical activity service; however, the availability, duration, size, and target population of the services varied depending on the individual FHT.

Estratégia da Saúde da Família em Manaus: uma avaliação dos aspectos administrativos e operacionais / Family Health Strategy in Manaus: an evaluation of the administrative and operational aspects

Objetivo: analisar o perfil de atuação das equipes de saúde do PSF, na cidade de Manaus, identificando seus aspectos administrativos e operacionais. Metodologia: a cidade de Manaus possuía, em 2007, 04 gestores, um para cada distrito e 114 equipes de saúde da família, sendo 53 de ESB. O estudo foi de natureza observacional, transversal, qualitativo e quantitativo. Constou na aplicação de dois questionários, o primeiro abordou os aspectos administrativos e o segundo, com aspectos operacionais. Foi utilizada estatística descritiva para a análise dos resultados e o programa DSC/QUALIQUANTISOFT, no método qualitativo para análise do discurso do sujeito coletivo. Resultados: em relação aos aspectos operacionais e administrativos destacam-se positivamente: cursos de capacitação e o universo dos usuários assistidos, satisfação da comunidade e a melhoria da atenção à saúde integral da comunidade e; negativamente: não organização da demanda, a precariedade física das UBS, o número reduzido das ESB frente à demanda da população, dificuldades no gerenciamento técnico das equipes, a gestão do sistema e dificuldades com a equipe de trabalho. Conclusão: Os resultados apresentados demonstraram dificuldades sérias na organização da demanda e principalmente na questão da referencia e contra-referencia.

Aim: of this study was to analyze the profile of work of health teams in the city of Manaus, identifying its administrative and operational aspects. Methodology: the city of Manaus had, in 2007, 04 managers, one for each district and 114 family health teams, 53 oral health. The study was observational, cross-sectional quantitative and qualitative and consisted of the application of two questionnaires,the first dealt with the administrative aspects and the second with the operational aspects. Descriptive statistics were used for the analysis of results and the program of the DSC/Qualiquantisoft, the qualitative method of collective subject speech. Results: in relation to operational and administrative aspects that stand out positively: training courses and the universe of users assisted, community satisfaction and improved health care and comprehensive community; negatively,no organization of demand, poor physical of office, the small number of office to fulfill the demand of the population, difficulties in managing technical teams, managing the system and difficulties with the team. Conclusion: the results demonstrated serious difficulties in organizing the demand.

A construção do plano local como atribuição das equipes de Saúde da Família: a experiência de três áreas programáticas do Município do Rio de Janeiro / The construction of the local plan as an attribution of the Family Healthy Team: the experience of three administrative regions in Rio de Janeiro city

As atribuições das equipes de Saúde da Família incluem a elaboração de um plano local, com participação da comunidade, considerando as peculiaridades e necessidades de saúde em cada território. Através de um estudo de caso com abordagem qualitativa, analisou-se o processo de planejamento local em três equipes, situadas em diferentes áreas programáticas do município do Rio de Janeiro. A seleção priorizou maior tempo de implantação e de estabilidade na composição das equipes, considerando a probabilidade de maior integração interna e junto a seus territórios. Participaram todos os profissionais das equipes e seus supervisores regionais. Os dados foram coletados através de observação direta das reuniões das equipes e entrevistas semiestruturadas. Optou-se pela análise de conteúdo com abordagem temática, utilizando as categorias teóricas de risco, vulnerabilidade e planejamento participativo. Os resultados mostraram um processo de planejamento local ainda incipiente, sem definição clara de metas comuns, subutilização de critérios e instrumentos preconizados, tendência normativa e focado em aspectos biológicos. Entre as sugestões para fazer avançar o planejamento, destacaram-se adequação do espaço físico nas unidades de saúde, estabilidade no fornecimento de insumos, regulação da rede de serviços, inclusão de um profissional administrativo em cada unidade de saúde e ações de educação permanente. Entende-se que a formulação e implementação de metodologias e instrumentos básicos capazes de traduzir as diretrizes da Estratégia de Saúde da Família e se adequar às peculiaridades de cada território, junto ao fortalecimento de uma cultura de planejamento participativo, se mostram fundamentais para a integração e qualificação do trabalho nessas equipes.

The powers of the Family Health teams include the development of a local plan, with community participation, considering the peculiarities and health needs in each territory. Through a case study with a qualitative approach, we analyzed the local planning process into three teams, located in different program areas of the municipality of Rio de Janeiro. The selection prioritized longer operation and stability in the composition of teams, considering the likelihood of greater internal integration and to their territories. All the professional teams and their regional supervisors participated. Data were collected through direct observation of meetings of teams and semi-structured interviews. We chose to approach content analysis with subject, using the theoretical categories of risk, vulnerability and participatory planning. The results showed a local planning process still in its infancy, no clear definition of common goals, criteria and underuse of recommended instruments, focused on regulatory trends and biological aspects. Among the suggestions for advancing the design, the highlights were the adequacy of physical space in health facilities, stable supply of raw materials, regulation of network services, including an administrative professional in every health unit actions and continuing education. It is understood that the formulation and implementation of methodologies and tools able to translate the basic guidelines of the Family Health Strategy and adapt to the peculiarities of each territory, with the strengthening of a culture of participatory planning is essential to show the integration and skilled labor in these teams.

Projeto de intervenção para qualificação da gestão do cuidado aos usuários de saúde mental e seus familiares na USF Prateado município de Pedra - PE / Intervention project for qualifying care management to mental health users and their families in the municipality of USF Silver PE

O Projeto Terapêutico Singular (PTS) é um conjunto de propostas de condutas terapêuticas articuladas não somente no plano biológico, para um sujeito individual ou coletivo, resultado da discussão coletiva de uma equipe interdisciplinar, com apoio matricial se necessário. A construção do PTS se dá com base nas necessidades de saúde de cada usuário, mediante esforço mútuo entre trabalhador/usuário/família com intuito de promover saúde mental. O presente projeto tem por objetivo a construção do Projeto Terapêutico Singular pela Equipe de Saúde da Família Prateado para qualificar a gestão do cuidado dos usuários do ambulatório de saúde mental e seus familiares. Para o desenvolvimento deste projeto será feito inicialmente capacitação dos profissionais de saúde quanto ao cadastramento dos usuários do ambulatório de saúde mental. Após isso será realizada capacitação com os Agentes Comunitários de Saúde sobre as abordagens aos usuários e familiares nas visitas domiciliares possibilitando diagnósticos prévios, minimizando as diferenças, as crises. Com este projeto de intervenção, pretendemos mostrar todo contexto que envolve a construção do Projeto Terapêutico Singular pela equipe de saúde da família, ao usuário do ambulatório de saúde mental e sua família, fragilizados pelo adoecer e suas conseqüências. Diante disso, torna-se necessário compromisso, responsabilidade, disponibilidade, intersetorialidade, conhecimentos profissionais e tecnológicos e compromisso ético para proporcionar um novo olhar na construção do PTS, bem como diante da relação e convívio entre trabalhador/usuários/família dentro de um contexto interdisciplinar, visando a melhoria do atendimento ao usuário de saúde mental da Unidade de Saúde da Família Prateado...